Prehospital Anticholinergic Burden Is Associated With Delirium but Not With Mortality in a Population of Acutely Ill Medical Patients

Rigor, Joana; Rato, Inês Rueff; Pereira, Rita Gonçalves; Ribeiro, Catarina; Teixeira, Diogo; Oliveira, Pedro Paulo Martins de; Silva, Ana Mafalda; Pereira, Sérgio Luís da Silva; Costa, I.; Ferreira, Paula; Sequeira, Manuela; Monteiro‐Soares, Matilde; Martins-Mendes, Daniela

doi:10.1016/j.jamda.2019.12.018

Cited by 13 publications

(30 citation statements)

References 35 publications

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“…The anticholinergic burden of drugs increased the risk for the development of ASD and SSD. The association between drugs with an anticholinergic burden and delirium has been reported in previous studies (29)(30)(31). Dementia was found to be a risk factor for ASD, as was reported in many previous studies that showed that impaired cognition (5,8) and dementia (3,32,33) were risk factors for delirium.…”

Section: Risk Factors For Deliriumsupporting

confidence: 67%

Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes

et al. 2020

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Background: The aim of the study was to assess the occurrence rate of delirium among elderly hospitalized patients in the medicine wards of a large tertiary hospital, to identify risk factors, and to evaluate the diagnostic rate for delirium among the medical teams. Methods: A 3-month prospective study of patients 65 years of age and above in three medicine wards: in two wards patients were examined by trained study team members using the Confusion Assessment Method (CAM), while the third was a control ward where CAM was not administered. The third ward served to control for the effect of the presence of investigators in the other wards as a potential confounding factor. Based on the results of this assessment patients were defined as suffering from subsyndromal delirium, full delirium (these two groups were later combined into an "any symptoms of delirium" group), and no delirium. The rate of diagnosis by the medical team was obtained from the electronic medical records. Results: The full delirium rate was 5.1%, the rate of subsyndromal delirium was 14.6%, and the rate of any symptoms of delirium was 19.6%. Absence of a partner, pain, anemia, hyponatremia, hypocalcemia, and the use of drugs with an anticholinergic burden were factors for any symptoms of delirium as well as for subsyndromal delirium. Subsyndromal delirium and any symptoms of delirium were associated with a reduced chance of being discharged to home and a higher 3-month mortality rate. A diagnosis of delirium was found in only 19.4% of the patients with any symptoms of delirium in the medical records. Conclusions: Delirium is a common problem among elderly hospitalized patients, but it is diagnosed sub-optimally by the medical team. There is a need for further training of the medical teams and implementation of delirium assessment as part of the ward's routine.

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Section: Risk Factors For Deliriumsupporting

confidence: 67%

Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes

et al. 2020

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“…For instance, MARANTE Scale lists only 41 drugs out of the 100 drugs in the Duran et al reference list 15 . Finally, the number of patients taking anticholinergic drugs users was lower than that found in the study by Rigor et al, i.e., 49% versus 72.7% 28 .…”

Section: Discussioncontrasting

confidence: 70%

“…Other studies have shown a positive association between delirium and anticholinergic burden 22,26,29 . This discrepancy may result from the great heterogeneity of the studies included in the literature reviews, whether due to the characteristics of the study (delirium is rarely the primary objective of the study), the study population (number of patients included, settings, age) or the scale used, the most commonly used scales being ACB and ADS 16,24,26,28 . According the litterature, only one study has analyzed modi ed ADS 22 and two other have evaluated MARANTE scale 14,30 , which make it di cult to compare.…”

Section: Discussionmentioning

confidence: 99%

Effect of anticholinergic burden on the onset of delirium in elderly hospitalized patientsassessed by 3 anticholinergic scales

Goy¹,

Epoupa²,

Naeije³

et al. 2021

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Background: Several studies have demonstrated the deleterious effects of anticholinergic drugs on the cognitive functions of the elderly. However, their effects on the onset of delirium have produced conflicting results. We assessed the association of the anticholinergic burden of treatment at admission according to 3 anticholinergic scales, the ADS, the modified ADS (mADS) and the Marante Scale on the onset of delirium in elderly hospitalized patients. We also analyzed the inter-rater reliability of the scales and their prognostic value in terms of length of stay and hospital mortality.Methods: This retrospective study included patients over 75 years of age hospitalized in medical and surgical departments between January 2014 and June 2019. Delirium was diagnosed by the Confusion Assessment Method (CAM). The anticholinergic burden was assessed by ADS, mADS and Marante Scale in patients with and without delirium.Results were reported as percentages for categorical variables and mean ± standard deviation (SD) and median [interquartile range] for continuous variables after Kolmogorov- Smirnov distribution test. Descriptive statistics were performed using paired Student t-test or Chi-square test. Spearman’s correlation was run to assess the inter-rater reliability between ADS, mADS and the Marante Scale. Results: Among the 1487 patients included, 26% developed delirium. No statistically significant difference in anticholinergic burden was observed between the delirium group and the control group, regardless of the anticholinergic scale used. The correlation coefficient was respectively 0.35 and 0.33 between ADS, mADS and the Marante Scale, and 0.97 between ADS and mADS (all p<0.001). None of the three scales were associated with length of stay, intra-hospital mortality, or one-year mortality. In multivariate analysis, ADS and mADS scores were independently associated with depression (p=0.003 and <0.0001), drug withdrawal (both p<0.001) and the number of drugs on admission (both p<0.001), and Marante Scale score was independently associated with living in a nursing home (p=0.018) and the number of drugs on admission (p<0.0001).Conclusions: Regardless of the scale used, we did not demonstrate a significant association between the anticholinergic burden of treatment upon admission and the onset of delirium during hospitalization.

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“…It is conceivable that anticholinergic adverse effects can promote the development of delirium, as this has already been observed in different settings. For example, associations were reported between the anticholinergic load according to the ACBS and the development of delirium in acutely ill patients [26,27], between the anticholinergic load according to the ARS and the development of delirium in frail older adults living in a nursing home [28], and between the increase in ARS score and development of delirium in palliative care inpatients [29].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Comparison of Three Anticholinergic Drug Scales in Older Adult Patients and Development of Postoperative Delirium: A Prospective Observational Study

et al. 2021

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Background Postoperative delirium (POD) is a frequent and serious complication after surgery. Evidence of a relationship between anticholinergic medication and the development of delirium is inconclusive, but studies on POD are rare. Objectives The objective of this study was to evaluate the anticholinergic load of preoperative medication in older adult patients and its association with the development of POD. Methods This investigation was part of the European BioCog project (http://www.bioco g.eu), a prospective multicenter observational study in older adult surgical patients (ClinicalTrials.gov identifier: NCT02265263, 15 October 2014). Patients with a Mini-Mental State Examination score ≤ 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method and a patient chart review. The preoperative anticholinergic load was calculated using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Cognitive Burden Scale (ACBS), and associations with POD were analyzed using logistic regression analysis adjusting for age, comorbidities, duration of anesthesia and number of drugs used. Results In total, 837 participants were included for analysis, and 165 patients (19.7%) fulfilled the criteria of POD. After adjusting for confounders, we found no association between preoperative anticholinergic load and the development of POD (ADS [points] odds ratio [OR] 0.928; 95% confidence interval [CI] 0.749-1.150; ARS [points] OR 0.832; 95% CI 0.564-1.227; ACBS [points] OR 1.045; 95% CI 0.842-1.296). Conclusion This study found no association between the anticholinergic load of drugs used preoperatively and the development of POD in older adult patients without severe preexisting cognitive impairment. Future analyses should examine the influence of intra-and postoperative administration of anticholinergic drugs as well as dosages of and interactions between medications.

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Prehospital Anticholinergic Burden Is Associated With Delirium but Not With Mortality in a Population of Acutely Ill Medical Patients

Cited by 13 publications

References 35 publications

Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes

Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes

Effect of anticholinergic burden on the onset of delirium in elderly hospitalized patientsassessed by 3 anticholinergic scales

Preoperative Comparison of Three Anticholinergic Drug Scales in Older Adult Patients and Development of Postoperative Delirium: A Prospective Observational Study

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